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1.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 627-632, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957751

RESUMO

Objective: To investigate the clinical characteristics and outcomes of monochorionic monoamniotic (MCMA) twin pregnancy. Methods: The clinical data of 60 MCMA twin pregnant women who were terminated in Peking University Third Hospital from January 2011 to December 2019 were collected, and the general clinical data, prenatal examination and pregnancy outcomes were analyzed retrospectively. Results: The age of 60 MCMA twin pregnant women was (31.0±4.1) years old, among which 44 cases were primiparas (73%, 44/60) and 16 cases were multiparas (27%, 16/60). Fifty-eight cases were diagnosed as MCMA twin pregnancy prenatally and were confirmed after delivery. Median ultrasonic diagnosis of gestational age was 12 weeks (range: 8-30 weeks). In the 60 MCMA twin pregnancies, 6 cases were conjoined twins, 5 cases were complicated with twin reversed arterial perfusion sequence (TRAPS), and 10 cases were diagnosed as other fetal malformation by prenatal ultrasound examination. Among the 60 MCMA twin pregnant women, 19 cases had spontaneous abortion or induced abortion due to fetal malformation, fetal death or other reasons within 28 weeks of pregnancy, 41 cases entered the perinatal period, a total of 70 newborns survived. The main cause of perinatal fetal or neonatal death was fetal dysplasia. Conclusions: There is a high incidence of fetal abnormality and perinatal mortality in MCMA twin pregnancy. Accurate early diagnosis, enhanced management and monitoring during pregnancy, and individualized treatment are the keys to improve MCMA twin pregnancy outcomes.


Assuntos
Âmnio/diagnóstico por imagem , Placenta/diagnóstico por imagem , Gravidez de Gêmeos , Gêmeos Monozigóticos , Ultrassonografia Pré-Natal/métodos , Adulto , Âmnio/fisiopatologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Mortalidade Perinatal , Placenta/fisiopatologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
2.
PLoS One ; 15(8): e0238315, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866202

RESUMO

BACKGROUND: In low resource settings recall of the date of the mother's last menstrual period may be unreliable and due to limited availability of prenatal ultrasound, gestational age of newborns may not be assessed reliably. Preterm babies are at high risk of morbidity and mortality so an alternative strategy is to identify them soon after birth is needed for early referral and management. OBJECTIVE: The objective of this study was to assess the accuracy in assessing prematurity of newborn, over and above birthweight, using a pictorial Simplified Gestational Age Score adapted for use as a Tablet App. METHODS: Two trained nurse midwives, blinded to each other's assessment and the actual gestational age of the baby used the app to assess gestational age at birth in 3 hospitals based on the following 4 parameters-newborn's posture, skin texture, breast and genital development. Inter-observer variation was evaluated and the optimal scoring cut-off to detect preterm birth was determined. Sensitivity and specificity of gestational age score using the tablet was estimated using combinations of last menstrual period and ultrasound as reference standards to assess preterm birth. The predictive accuracy of the score using the area under a receiver operating characteristic curve was also determined. To account for potential reference standard bias, we also evaluated the score using latent class models. RESULTS: A total of 8,591 live singleton births whose gestational age by last menstrual period and ultrasound was within 1 weeks of each other were enrolled. There was strong agreement between assessors (concordance correlation coefficient 0.77 (95% CI 0.76-0.78) and Fleiss' kappa was 0.76 (95% CI 0.76-0.78). The optimal cut-off for the score to predict preterm was 13. Irrespective of the reference standard, the specificity of the score was 90% and sensitivity varied from 40-50% and the predictive accuracy between 74%-79% for the reference standards. The likelihood ratio of a positive score varied between 3.75-4.88 while the same for a negative likelihood ratio consistently varied between 0.57-0.72. Latent class models showed similar results indicating no reference standard bias. CONCLUSION: Gestational age scores had strong inter-observer agreement, robust prediction of preterm births simplicity of use by nurse midwives and can be a useful tool in resource-limited scenarios. TRIAL REGISTRATION: The Tablet App for the Simplified Gestational Age Score (T-SGAS) study was registered at ClinicalTrials.gov NCT02408783.


Assuntos
Recém-Nascido Prematuro/fisiologia , Parto/fisiologia , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/fisiopatologia , Peso ao Nascer/fisiologia , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Aplicativos Móveis , Gravidez , Medição de Risco/métodos , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/métodos
3.
Cir. pediátr ; 33(3): 143-145, jul. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193557

RESUMO

INTRODUCCIÓN: La hernia de Amyand consiste en la presencia del apéndice cecal en el saco herniario, generalmente en localización derecha, aunque se recogen casos de localización izquierda debido a malrotación intestinal. EXPOSICIÓN DEL CASO: Lactante varón de 3 meses de edad, con onfalocele diagnosticado en la 12ª semana de gestación e intervenido a las 48 horas del nacimiento. Durante el seguimiento se diagnostica de hernia inguinal bilateral, realizando herniotomía bilateral programada. En la intervención se encuentra el apéndice cecal en el saco herniario izquierdo, procediendo a una apendicectomía profiláctica. COMENTARIOS: La incidencia de la hernia de Amyand es del 0,4-1% (3 veces más frecuente en población pediátrica). La localización izquierda suele asociarse a alteraciones en la rotación intestinal. El tratamiento de las hernias de Amyand derechas se recoge en la clasificación de Losanoff-Basson. En las izquierdas, se recomienda realizar apendicectomía profiláctica para evitar confusiones diagnósticas en caso de apendicitis


INTRODUCTION: Amyand's hernia is defined as the presence of the cecal appendix inside the hernia sac. It is usually located on the right side, but left-sided cases due to intestinal malrotation have also been reported. CASE PRESENTATION: 3-month-old male infant diagnosed with omphalocele at the 12th week of gestation undergoing surgery 48 hours post-birth. Bilateral inguinal hernia was diagnosed during follow-up, so scheduled bilateral herniotomy was performed. During surgery, the cecal appendix was identified inside the left herniary sac, so prophylactic appendectomy was carried out. CONCLUSIONS: The incidence of Amyand's hernia ranges from 0.4 to 1% - three times higher in pediatric patients. Left-sided hernias are often associated with intestinal rotation disorders. Treatment of right Amyand's hernia is described in Losanoff-Basson's classification. In left-sided hernias, prophylactic appendectomy is recommended to avoid diagnostic confusion in case of appendicitis


Assuntos
Humanos , Masculino , Lactente , Hérnia Umbilical/cirurgia , Hérnia Inguinal/cirurgia , Apendicectomia/métodos , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal/métodos , Hérnia Inguinal/classificação
4.
PLoS One ; 15(6): e0235269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603339

RESUMO

Many high-risk conditions of pregnancy are undetected until the time of delivery in low-income countries. We developed a point-of-care ultrasound training protocol for providers in rural Uganda to detect fetal distress or demise, malpresentation, multiple gestation, placenta previa, oligohydramnios and preterm delivery. This was a mixed-methods study to evaluate the 2-week training curriculum and trainees' ability to perform a standard scanning protocol and interpret ultrasound images. Surveys to assess provider confidence were administered pre-training, immediately after, and at 3-month follow up. Following lecture and practical demonstrations, each trainee conducted 25 proctored scans and were required to pass an observed structured clinical exam (OSCE). All images produced 8 weeks post course underwent blinded review by two ultrasound experts to assess image quality and to identify common errors. Key informant interviews further assessed perceptions of the training program and utility of point-of-care ultrasound. All interviews were audio recorded, transcribed, and reviewed by multiple readers using a content analysis approach. Twenty-three nurse/nurse midwives and two physicians from one district hospital and three health centers participated in the training curriculum. Confidence levels increased from an average of 1 point pre-course to over 6 points post-course for all measures (maximum of 7 points). Of 25 participants, 22 passed the OSCE on the first attempt (average score 89.4%). Image quality improved over time; the final error rate at week 8 was less than 5%, with an overall kappa of 0.8-1 for all measures between the two reviewers. Among the 12 key informant interviews conducted, key themes included a desire for more hands-on training and longer duration of training and challenges in balancing clinical duties with ability to attend training sessions. This study demonstrates that providers without previous ultrasound experience can detect high-risk conditions during labor with a high rate of quality and accuracy after training.


Assuntos
Enfermeiras Obstétricas/educação , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Feminino , Humanos , Trabalho de Parto , Tocologia/educação , Obstetrícia/educação , Gravidez , População Rural , Triagem , Uganda , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/enfermagem
5.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 51-57, abr.-jun. 2020. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-191314

RESUMO

Los miomas uterinos son una de las patologías ginecológicas más comunes encontrándose hasta en el 70% de las mujeres de raza caucásica y en el 80% de las mujeres de raza negra1,2. En los últimos años, la angiogénesis y la vascularización se han convertido en pieza fundamental de estudio del crecimiento de los tumores. En el caso de los miomas uterinos se ha descubierto que existen diferencias en la vascularización cuando se compara con el tejido uterino adyacente. La patogenia de los miomas es multifactorial existiendo varias vías que intervienen en el crecimiento de los mismos como la vía estrogénica, la progestagénica y la de los factores de crecimiento3. Otra de las vías qué influyen en su desarrollo es la vía de la vitamina D. Niveles inadecuados de dicha vitamina pueden favorecer el crecimiento de los mismos. En nuestro trabajo hemos analizado cómo influye la terapia con vitamina D en el volumen de los miomas y en su vascularización mediante el análisis sérico de VEGF y ecografía 3 DPW


Uterine fibroids are one of the most common gynaecological disorders, being found in 70% of Caucasian women and 80% of Afro-Caribbean women 1,2. In recent years, angiogenesis and vascularisation have become a key part of study of tumour growth. Differences in vascularisation have been discovered in uterine fibroids when compared to adjacent uterine tissue. The pathogenesis of uterine fibroids is multifactorial. Several pathways are involved in their growth have been described, such as the oestrogen pathway, the gestagen pathway, and the pathway of the growth factors. Another of the pathways that influences their development is the vitamin D pathway, as inadequate levels of this vitamin may favour the growth of uterine fibroids3. In this work, an analysis is made on how vitamin D therapy influences the volume and vascularity of uterine fibroids, using serum VEGF levels and 3DPW Ultrasound


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Leiomioma/diagnóstico por imagem , Leiomioma/terapia , Projetos Piloto , Vitamina D/administração & dosagem , Neovascularização Patológica/diagnóstico por imagem , Fatores de Crescimento Endotelial/sangue , Leiomioma/patologia , Neovascularização Patológica/sangue , Neovascularização Patológica/patologia , Ultrassonografia Pré-Natal/métodos , Leiomioma/classificação
6.
PLoS One ; 15(6): e0233179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584813

RESUMO

Currently available fetal echocardiographic reference values are derived mainly from North American and European population studies, and there is a lack of reference z-score for fetal echocardiographic measurement in Asian populations. The aim of this study was to establish normal ranges of echocardiographic measurements and z-scores in healthy Asian fetuses. A total of 575 healthy pregnant Taiwanese with an estimated gestational age from 14 to 38 weeks were enrolled voluntarily for this observational study. Standard two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries of the developing fetuses. In contrast to past studies, our sample was more evenly distributed for estimated gestational age (p<0.001). We present percentile graphs for 13 fetal echocardiographic measurements from the knowledge of estimated gestational age, biparietal distance, head circumference, abdominal circumference, and femur length. Most cardiac structures and developmental markers had linear models as the best-fitting, except for transverse aortic isthmus by estimated gestational age and transverse ductus arteriosus by femur length. Our findings indicate that estimated gestational age was generally the best model for fetal heart development, while head circumferences could be used as an optimal developmental marker to predict left atrium, right atrium, right ventricle, pulmonary annulus, and ductus arteriosus. Lastly, we developed nomograms for each of the 13 fetal heart measurements by each developmental markers. This is the first study providing echocardiographic reference ranges and nomograms for Asian fetuses. Computing z-scores from nomograms helps in standardizing comparisons and adds additional prognostic information to the diagnosis of congenital heart disease.


Assuntos
Ecocardiografia/normas , Monitorização Fetal/métodos , Grupo com Ancestrais do Continente Asiático , Ecocardiografia/métodos , Feminino , Desenvolvimento Fetal , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Modelos Lineares , Gravidez , Valores de Referência , Ultrassonografia Pré-Natal/métodos
7.
Arch Gynecol Obstet ; 302(3): 619-628, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32556516

RESUMO

INTRODUCTION: Neural tube defects (NTDs) are a group of heterogeneous congenital anomalies of the central nervous system (CNS). Acrania is a non-NTD congenital disorder related to the CNS. It can transform into anencephaly through the acrania-exencephaly-anencephaly sequence (AEAS). In AEAS, the cerebral tissue is not protected and is gradually destroyed due to exposure to the harmful effect of amniotic fluid and mechanical injuries. These lead to exencephaly and then into anencephaly. In contrast to primary anencephaly (NTDs), this type of anencephaly authors suggests calling secondary anencephaly. OBJECTIVE: Analysis of the known prenatal ultrasonography (US) signs associated with AEAS. Simultaneously, the authors propose a new sign in the differentiation of acrania from exencephaly and anencephaly, called the "beret" sign. METHODS: It is a two-centre retrospective observational study. As part of the study, 4060 US scans were analyzed. RESULTS: In 10 cases, the absence of calvarium was diagnosed, allowing recognition of either AEAS stages or primary anencephaly. In 5 cases, cerebral structures were enclosed by an inertial rippled thin membrane, with a smooth outer contour. Between the described membrane and the brain structures, a thin anechoic space corresponding to cerebrospinal fluid was observed. This sign was defined as the "beret" sign. In these cases, acrania was diagnosed. In three cases calvarium was missing. The brain structures had an irregular appearance, did not wave and remained motionless. The outer contour was unequal as if divided into lobes. Amniotic fluid was anechoic. Exencephaly was diagnosed in these cases. In two cases calvarium, brain structures, and meninges were missing. The "frog eyes" sign and slightly echogenic amniotic fluid were visible. In this case, anencephaly was diagnosed. CONCLUSIONS: The "beret" sign seems to be a promising tool in the diagnosis of acrania. Furthermore, echogenicity of amniotic fluid could be useful during differentiation between primary and secondary anencephaly.


Assuntos
Anencefalia/diagnóstico por imagem , Defeitos do Tubo Neural/diagnóstico por imagem , Crânio , Ultrassonografia Pré-Natal/métodos , Líquido Amniótico , Anencefalia/complicações , Anencefalia/diagnóstico , Biomarcadores , Encéfalo/anormalidades , Feminino , Humanos , Recém-Nascido , Defeitos do Tubo Neural/complicações , Gravidez , Estudos Retrospectivos , Crânio/anormalidades , Crânio/diagnóstico por imagem , Ultrassonografia
8.
PLoS One ; 15(5): e0233023, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401826

RESUMO

Zika virus (ZIKV) is a mosquito-transmitted flavivirus, recently linked to microcephaly and central nervous system anomalies following infection in pregnancy. Striking findings of disproportionate growth with a smaller than expected head relative to body length have been observed more commonly among fetuses with exposure to ZIKV in utero compared to pregnancies without ZIKV infection regardless of other signs of congenital infection including microcephaly. This study's objective was to determine the diagnostic accuracy of femur-sparing profile of intrauterine growth restriction for the identification of ZIKV-associated congenital injuries on postnatal testing. A retrospective cohort study of pregnant women with possible or confirmed ZIKV infection between January 1, 2016 and December 31, 2017 were included. Subjects were excluded if no prenatal ultrasound was available. A femur-sparing profile of growth restriction determined using INTERGROWTH-21st sonographic standard for head circumference to femur length (HC: FL). Congenital injuries were determined postnatally by imaging, comprehensive eye exam and standard newborn hearing screen. A total of 111 pregnant women diagnosed with ZIKV infection underwent fetal ultrasound and 95 neonates had complete postnatal evaluation. Prenatal microcephaly was detected in 5% of fetuses (6/111). Postnatal testing detected ZIKV-associated congenital injuries in 25% of neonates (24/95). A HC: FL Z-score ≤ -1.3 had a 52% specificity (95% CI 41-63%), 82% negative predictive value (NPV, 95% CI 73-88%) for the detection of ZIKV-associated congenital injuries in the neonatal period. A more stringent threshold with a Z-score ≤ -2 was associated with a 90% specificity (95% CI 81-95%), 81% NPV (95% CI 77-85%). Excluding cases of fetal microcephaly, HC: FL (Z-score ≤ -2) demonstrated a similar specificity (89%, 95% CI 81-95%) with superior NPV (87%, 95% CI 84-90%). The sonographic recognition of a normally proportioned fetus may be useful prenatally to exclude a wider spectrum of ZIKV-associated congenital injuries detected postnatally.


Assuntos
Fêmur/embriologia , Retardo do Crescimento Fetal/diagnóstico por imagem , Microcefalia/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Infecção por Zika virus/complicações , Feminino , Fêmur/diagnóstico por imagem , Desenvolvimento Fetal , Humanos , Microcefalia/epidemiologia , Cuidado Pós-Natal , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Infecção por Zika virus/congênito
9.
Arch Gynecol Obstet ; 302(2): 337-343, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32451659

RESUMO

PURPOSE: The objective of this study was to evaluate the feasibility and value of measuring early placental echogenicity to predict fetal intrauterine growth restriction (IUGR). METHODS: This is a single center, retrospective cohort study. Early ultrasound examination (6 + o to 8 + 6 weeks of gestation in singleton pregnancies) was used to measure placental dimensions and placental echogenicity. A ratio between placental echogenicity and myometrial echogenicity (PE/ME-ratio) was calculated for each patient. Study population was assigned to either the IUGR group or the control group based on clinical data. RESULTS: 184 eligible pregnancies were analysed. 49 patients were included in our study. Of those, 9 (18.37%) cases were affected by IUGR and 40 (81.63%) were controls. Measuring the placental echogenicity was feasible in all cases. IUGR neonates had a significant lower placental echogenicity (1.20 (± 0.24) vs. 1.64 (± 0.60), p = 0.033), but no significant differences in the other placental outcomes were observed. CONCLUSION: Our results showed that measuring placental echogenicity is feasible in the early first trimester and demonstrated a significantly lower placental echogenicity in fetuses with subsequent IUGR. Further prospective studies are needed to validate those results.


Assuntos
Retardo do Crescimento Fetal/diagnóstico por imagem , Placenta/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Estudos de Viabilidade , Feminino , Retardo do Crescimento Fetal/diagnóstico , Humanos , Recém-Nascido , Projetos Piloto , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
Pediatr Cardiol ; 41(6): 1125-1134, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32367304

RESUMO

To assess the fetal cardiac function and ventricular volumes by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods in fetuses from pre-gestational diabetic women. This was a prospective and cross-sectional study that evaluated 53 fetuses from pre-gestational diabetic women and 53 fetuses from healthy mothers between 20 and 34 weeks of gestation. Only fetuses with no structural or genetic abnormalities and singleton pregnant women were included in this study. The fetal cardiac volumes were assessed by STIC and VOCAL methods. The ejection fraction, stroke volume, and cardiac output were calculated from these measurements to evaluate fetal cardiac function. The Mann-Whitney U test was performed to compare the two groups. For calculation of intra- and interobserver reproducibility's, we used concordance correlation coefficients. The mean differences in the right atrial volumes between the diabetic and normal groups ranged from 0.05 mL to 0.1 mL (p = 0.917 and 0.355, respectively). The median of left atrium (LA) volume measurement in pre-gestational diabetic group was significantly lower than healthy mothers (LA: 0.62 vs. 0.68 mL; p < 0.001). The fetal right and left ventricular volumes were similar in both groups. No significant differences in ejection fraction, stroke volume and cardiac output were observed (p value range 0.086-0.815). The majority of fetal atrial/ventricular volumes showed good intra- and interobserver reliabilities. Conversely, the majority cardiac function parameters showed poor intra- and interobserver agreements. STIC and VOCAL methods gave reproducible quantitative results for fetal atrial and ventricular volumes. Significant differences in fetal left atrial volumes were observed between the two groups, which be related to LA atrial dysfunction and /or left ventricle (LV) compliance, reflecting earlier stages of cardiac dysfunction.


Assuntos
Diabetes Gestacional/fisiopatologia , Ecocardiografia Tridimensional/métodos , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Volume Cardíaco , Estudos de Casos e Controles , Estudos Transversais , Diabetes Gestacional/diagnóstico por imagem , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Volume Sistólico , Adulto Jovem
19.
Ultrasound Obstet Gynecol ; 56(1): 106-109, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32337795

RESUMO

Lung ultrasound has been suggested recently by the Chinese Critical Care Ultrasound Study Group and Italian Academy of Thoracic Ultrasound as an accurate tool to detect lung involvement in COVID-19. Although chest computed tomography (CT) represents the gold standard to assess lung involvement, with a specificity superior even to that of the nasopharyngeal swab for diagnosis, lung ultrasound examination can be a valid alternative to CT scan, with certain advantages, particularly for pregnant women. Ultrasound can be performed directly at the bed-side by a single operator, reducing the risk of spreading the disease among health professionals. Furthermore, it is a radiation-free exam, making it safer and easier to monitor those patients who require a series of exams. We report on four cases of pregnant women affected by COVID-19 who were monitored with lung ultrasound examination. All patients showed sonographic features indicative of COVID-19 pneumonia at admission: irregular pleural lines and vertical artifacts (B-lines) were observed in all four cases, and patchy areas of white lung were observed in two. Lung ultrasound was more sensitive than was chest X-ray in detecting COVID-19. In three patients, we observed almost complete resolution of lung pathology on ultrasound within 96 h of admission. Two pregnancies were ongoing at the time of writing, and two had undergone Cesarean delivery with no fetal complications. Reverse transcription polymerase chain reaction analysis of cord blood and newborn swabs was negative in both of these cases. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto , Infecções por Coronavirus/virologia , Feminino , Humanos , Recém-Nascido , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/métodos
20.
Obstet Gynecol ; 135(5): 1185-1197, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32282593

RESUMO

OBJECTIVE: To examine the relationship between prenatal diagnostics (ultrasound examination and amniotic fluid Zika virus testing) and postnatal congenital Zika syndrome abnormalities. DATA SOURCES: Systematic searches were performed in 27 databases, including ClinicalTrials.gov, from inception to July 1, 2019, for articles with the keywords "Zika," "prenatal," "ultrasound," and "amniocentesis." METHODS OF STUDY SELECTION: A total of 3,049 unique records were identified. Two reviewers independently assessed titles, abstracts, and full texts for relevance; 84 articles met the inclusion criteria. These articles describe 402 mother-fetus or mother-neonate dyads; 385 were included in the review of prenatal ultrasound examination, and 56 in the review of amniocentesis (39 in both). TABULATION, INTEGRATION, AND RESULTS: Among 195 fetuses with congenital Zika syndrome findings on prenatal ultrasound examination, postnatal congenital Zika syndrome abnormalities were reported for 153 (78%; 95% CI 7-84%). High proportions of microcephaly (76%; 95% CI 69-82%) and brain abnormalities (78%; 95% CI 69-86%) were confirmed postnatally. Among 190 fetuses without congenital Zika syndrome findings on prenatal ultrasound examination, 17% (95% CI 12-24%) had congenital Zika syndrome abnormalities identified postnatally. Structural congenital Zika syndrome abnormalities were identified postnatally in approximately equal proportions among dyads with and without Zika virus RNA detected in an amniotic fluid specimen (68% and 67%; 95% CI 52-82% and 95% CI 38-88%). In six pregnancies, Zika virus RNA was detected in amniotic fluid but not in a subsequent amniocentesis specimen. CONCLUSION: Prenatal ultrasound examination frequently detects structural findings associated with Zika virus infection; however, not all abnormalities are detected, and some may represent transient findings. As with other congenital infections, prenatal detection may vary with timing of infection, timing of ultrasound examination, technical expertise, and severity of abnormalities. The detection of Zika virus RNA in amniotic fluid in the included studies did not predict the risk for congenital Zika syndrome abnormalities in these cases, and clearance of Zika virus RNA from amniotic fluid appears possible after maternal infection. Diagnostic testing for Zika virus infection remains a shared decision between patients and clinicians, and more data are needed to define clinical predictors that will inform these decisions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018080959.


Assuntos
Amniocentese/métodos , Doenças Fetais/diagnóstico , Ultrassonografia Pré-Natal/métodos , Infecção por Zika virus/diagnóstico , Zika virus , Adulto , Feminino , Doenças Fetais/virologia , Humanos , Gravidez , Adulto Jovem , Infecção por Zika virus/embriologia , Infecção por Zika virus/virologia
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